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宫内压力导管的应用

Authors
Jaimey M Pauli, MD
John T Repke, MD
Section Editor
Susan M Ramin, MD
Deputy Editor
Vanessa A Barss, MD, FACOG
Translators
和儒林, 主治医师

引言

宫缩的频率、持续时间和强度是评估产程进展和判断胎心率类型的重要因素。利用宫内压力导管(intrauterine pressure catheter, IUPC)(图片 1)进行体内分娩力测定是评估子宫活动的一种可靠的定量方法，无需触诊，而且几乎不受干扰[1,2]。

产程中的子宫活动可以用体外触诊或体外分娩力测定来监测，而不用IUPC。体外触诊很主观，要求临床医生在场进行频繁检查，而且不能减轻行连续体外胎心监测的患者的不适。体外分娩力测定不要求临床医生在场，可以客观记录宫缩的频率和持续时间，但描记图形可能因产妇移动而中断，也不能定量评估宫缩强度。子宫电图描记(electrohysterography)是一种新型的子宫监测方法，通过放置在产妇腹部的电极测量子宫肌肉的电活动。有研究评估了该方法用于预测早产临产和作为体内监测的潜在无创替代方法的效果；但尚需大型随机试验证实其临床实用性[3-5]。

本专题将讨论IUPC在临床上监测产程中子宫活动的应用。产时正常和异常子宫活动的诊断及产程延长和产程停滞的管理将单独讨论。 (参见“正常分娩和产程延长及停滞的概述”)

临床应用

IUPC不会常规用于监测自然临产、引产或催产的子宫活动，因为与体外监测相比，常规使用IUPC不能改善产妇和胎儿的结局，还会增加成本、复杂性和并发症(参见下文‘并发症’)。2013年的一项系统评价纳入了3项随机试验，近2000例接受引产或催产的女性，结果显示，体内与体外分娩力测定相比对所有产妇和新生儿结局(如，阿普加评分、脐动脉血pH<7.15、收入新生儿重症监护病房、剖宫产及阴道助产、过度刺激)均无显著影响[6]。

然而，有些临床情况下采用体内监测比体外分娩力测定更好。例如：

             

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Literature review current through: 2017-06 . | This topic last updated: 2016-08-10.
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